Laporan Kelompok PBL Sistem Imunologi
MODUL 1
”BERCAK MERA PADA KULI!”
Disusun Oleh : KELOMPOK "
# Tutor # $r% &D% Sitti As'ia( U$u) M%S*
PRO+RAM S!UDI PE,DIDIKA, DOK!ER -AKUL!AS KEDOK!ERA, U,I.ERSI!AS ALUOLEO KE,DARI /01
A,++O!A KELOMPOK "
1. 2. . #. %. (. ". $. 9.
NUR NUR RAHM RAHMA A K1A1 K1A1 12 091 091 YUNITA YUSUF K1A1 12 10 !ISNA ANDRIANI K1A1 12 11" RISKA K1A1 12 11$ M&'AHA RAY K1A1 12 1# NUR NURU' ANU)R NU)RAH AH !U'A !U'AND NDAR ARII K1A1 K1A1 12 1% 1% AHMAD ARI&F *.+ K1A1 1 002 A.M AKRAMU''AH D&NDI. * K1A1 1 00# R&FI R&FI FARADI ARADI'AH 'AH K1A1 K1A1 1 0#9
KA!A PE,+A,!AR PE,+ A,!AR
Assalamualikum wr wb Alhamdulillah hirobbil’alamin, ,u-i /n suur /i 3/n-/t/n eh/ir/t All/h S!T4 tuh/n 3en5i3t/ seluruh /l/ seest/ 6es/rt/ isin/4 /ren/ tel/h e6eri/n r/h/t /n hi//hn/ sehin77/ /i /3/t eneles/i/n l/3or/n ini te3/t 3// 8/tun/4 t/ lu3/ s/l/8/t /n s/l/ /i -un-un7/n e3// R/sulull/h SA!4 /n7 tel/h e6/8/ it/ seu/ /ri //n -/hili/h e3// //n /n7 ter/n7 6ener/n7.
D/l/ r/n7/ elen7/3i tu7/s tutori/l I siste Iunolo7i /i e6u/t l/3or/n ini. U5/3/n teri//sih se6es/r6es/rn/ /i 6eri/n e3// tutor /i /itu r. !D.Sitti As;i/h4 M.S54 /n7 tel/h e6i6in7 /i sel// tutori/l4 /n te/nte/n elo3o /n7 tel/h o3/ 6erus/h/ untu eneles/i/n l/3or/n ini. Me/n7 6u/nl/h h/l /n7 u/h /l/ enusun l/3or/n ini4 n/un /i tel/h 6erus/ se/si/l un7in /n 6ersun77uhsun77uh /l/ eneles/i/nn/.
K/i 3un en//ri 6/h8/ /sih 6/n/ eur/n7/n /l/ 3e6u/t/n l/3or/n ini4 6/i /ri se7i 3enulis/n4 isi /u3un in;or/si /n7 ter/3/t /l/ l/3or/n ini4 oleh /ren/ itu /i ohon //; /n7 se6es/r6es/rn/4 /n ohon s/r/n4 riti /n /su/n /ri 3/r/ 3e6/5/ se/li/n sehin77/ /3/t ee3urn//n /l/ 3roses 3e6u/t/n l/3or/n sel/n-utn/.
Ahir /t/4 /i s/n7/t 6erteri/ /sih e3// 3/r/ 3e6/5/4 teristie8/ e3// ere/ /n7 6eren/n e6eri/n riti /n s/r/nn/. H/r/3/n /i 4 seo7/ l/3or/n ini 6er/n;//t untu it/ seu/. Amin ya robbal’alamin. Wassalamualikum wr wb Ken/ri4 Fe6ru/ri 201%
PenulisBAB I PE,DAULUA, PE,DAULA,
Kulit //l/h or7/n tu6uh /n7 terlet/ 3/lin7 lu/r /n e6/t/sin/ /ri lin7un7/n hiu3 /nusi/. 'u/s ulit or/n7 e8/s/ 14% < en7/n 6er/t ir/ir/ 1% = 6er/t 6//n. Kulit eru3//n or7/n /n7 esensi/l /n >it/l sert/ eru3//n 5erin eseh/t/n /n ehiu3/n. Kulit -u7/ s/n7/t o3les4 el/stis /n sensiti;4 6er>/ri/si 3// e///n ili4 uur ses4 r/s /n -u7/ 6er7/ntun7 3// lo/si tu6uh. !/rn/ ulit 6er6e/6e/4 /ri ulit /n7 6er8/rn/ ter/n7 ?;/ir sin@4 3ir/n7 /n hit/4 8/r/ er/h u/ 3// tel/3/ /i /n t/n7/n 6/i4 sert/ 8/rn/ hit/ e5ol/t/n 3// 7enit/li/ or/n7 e8/s/. Deii/n 3ul/ ulit 6er>/ri/si en7en/i le6ut ti3is /n te6/ln/ ulit /n7 el/stis /n lon77/r ter/3/t 3// 3/l3e6r/4 6i6ir /n 3re3utiu4 ulit /n7 te6/l /n te7/n7 ter/3/t i tel/3/ /i /n t/n7/n e8/s/. Kulit /n7 ti3is ter/3/t 3// u/4 /n7 le6ut 3// leher /n 6//n /n /n7 6er/6ut /s/r ter/3/t 3// e3/l/.
!U2UA, PEMBELA2ARA,
Setel/h seles/i e3el/-/ri oul ini /h/sis8/ ih/r/3/n /3/t ene6ut/n re/si hi3ersensiti; /n7 ene6/6/n 6er5/ er/h 3// ulit /n en-el/s/n tent/n7 3ene6/64 3etoe/nise re/si /n7 6ers/n7ut/n4 terut// iuno3/to7enesis ter-/in/ re/si ini4 erus//n -/rin7/n4 t/n/B7e-/l/ /n7 iteu/n4 5/r/ i/7nosis 3enun-/n74 sert/ 3en/t/l/s/n//n /sus /n7 6ers/n7ut/n.
BAB II PEMBAASA, /%1 SKE,ARIO
Seor/n7 i6u ru/h t/n77/ 6eruur 20 t/hun /t/n7 e oter 3r/te s8/t/ en7/n eluh/n 6er5/ eer/h/n 6er6/t/s te7/s i 3er7el/n7/n t/n7/n. Mun5ul # h/ri /n7 l/lu. +er5/ terse6ut /7/ h/n7/t 3// 3er/6//n4 ter/s/ 7/t/l /n ti/ // neri 3// 3ene/n/n. Kel/in/n ini si;/tn/ /6uh/n terut// setel/h en5u5i. 'o/si el/in/nn/ 6is/ i sel/ C sel/ -/ri t/n7/n /t/u i sel/ -/ri /i.
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/%/ KA!A KU,CI I6u ru/h t/n77/ 20 t/hun +er5/ eer/h/n +er6/t/s te7/s i 3er7el/n7/n t/n7/n Mun5ul # h/ri /n7 l/lu Ter/s/ h/n7/t4 7/t/l /n ti/ neri 6il/ ite/n Si;/tn/ /6uh/n terut// setel/h en5u5i 'o/si 6is/ i sel/ -/ri t/n7/n /n /i
1. 2. . #. %. (. ". $. 9.
/%" PER!A,3AA, +/7/i/n/ /n/toi4 histolo7i /n ;isiolo7i ulit *el/s/n e;inisi hi3ersensiti>it/s /n se6ut/n 3e6/7i/nn/ Di;enti/l Di/7nosis /n Di/7nosi Seent/r/ *el/s/n e/nise hi3ersensiti>it/s ti3e 1 &tiolo7i /ri Di/7nosi Seent/r/ &3ieiolo7i Di/7nosi Seent/r/ ,eeris//n 3enun-/n7 Di/7nosi Seent/r/ ,en/t/l/s/n//n Di/7nosi Seent/r/ Ko3li/si /n 3ro7nosis /ri Di/7nosi Seent/r/
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/%4 2A&ABA, PER!A,3AA, 1% A,A!OMI) IS!OLO+I DA, -ISIOLO+I KULI! A,A!OMI KULI!
Kulit se5/r/ 7/ris 6es/r tersusun /t/s ti7/ l/3is/n ut// /itu: /. '/3is/n e3ieris /t/u utiel 6. '/3is/n eris ?oriu4 utis >er/4 true skin@ 5. '/3is/n su6utis ?hi3oeris@
Ti/ // 7/ris te7/s /n7 eis/h/n eris /n su6utis4 su6utis it/n/i en7/n //n/ -/rin7/n i/t lon77/r /n //n/ sel /n -/rin7/n le/. 1. Lapisan epi$ermis teriri /t/s : str/tu orneu4 str/tu lusiu4 str/tu 7r/nulosu4 str/tu s3inosu4 /n str/tu 6/s/le.
Stratum korneum ?l/3is/n t/nu@ //l/h l/3is/n ulit /n7 3/lin7 lu/r
/n teriri /t/s 6e6er/3/ l/3is selsel 7e3en7 /n7 /ti4 ti/ 6erinti4 /n
3roto3l/s/n/ tel/h 6eru6/h en-/i er/tin ?/t t/nu@. Stratum lusi$um ter/3/t l/n7sun7 i6/8/h l/3is/n orneu eru3//n l/3is/n selsel 7e3en7 t/n3/ inti en7/n 3roto3l/s/ /n7 6eru6/h en-/i 3rotein /n7 ise6ut eleiin. '/3is/n terse6ut t/3/ le6ih -el/s i tel/3/ t/n7/n /n /i.
Stratum granulosum ?l/3is/n er/tohi/lin@ eru3//n 2 /t/u l/3is sel
sel 7e3en7 en7/n sito3l/s/ 6er6utir /s/r /n ter/3/t inti i/nt/r/n/. +utir6utir /s/r ini teriri /t/s er/tohi/lin. Muos/ 6i/s/n/ ti/ e3un/i l/3is/n ini. Str/tu 7r/nulosu -u7/ t/3/ -el/s i tel/3/
t/n7/n /n /i. Stratum spinosum ?str/tu /l3i7hi@ /t/u ise6ut 3ul/ prickle cell layer ?l/3is/n //nt/@ teriri /t/s 6e6er/3/ l/3is sel /n7 6er6entu 3oll7on/l /n7
6es/rn/
6er6e/6e/
/ren/
//n/
3roses
itosis.
,roto3l/s/n/ -ernih /ren/ 6/n/ en7/nun7 7lioi7en4 /n inti terlet/ i ten7/hten7/h. Sel sel ini /in e/t e 3eru//n /in 7e3en7 6entun/. Di /nt/r/ selsel str/tu s3inoisu ter/3/t -e6/t/n -e6/t/n /nt/r sel ?intercelullar bridges) /n7 teriri /t/s 3roto3l/s/ /n tono;i6ril /t/u er/tin. ,erle/t/n /nt/r -e6/t/n-e6/t/n ini e6entu 3ene6/l/n 6ul/t e5il /n7 ise6ut noulus +ioero. Di /nt/r/n/ selsel s3inoisu ter/3/t 3ul/ sel '/n7erh/ns. Selsel Str/tu
s3inosu en7/nun7 6/n/ 7lio7en. Stratum 5asale teriri /t/s selsel 6er6entu u6us ?olun/r@ /n7 tersusun >erti/l 3// 3er6/t/s/n eroe3ier/l 6er6/ris se3erti 3/7/r ? palisade@. '/3is/n ini eru3//n l/3is/n e3ieris /n7 3/lin7 6/8/h. Selsel 6/s/l ini en7///n itosis /n 6er;un7si re3rousi. '/3is/n ini teriri /t/s u/ -enis sel /itu: /. Selsel /n7 6er6entu kolumnar en7/n 3roto3l/s/ 6/so;ili inti lon-on7 /n 6es/r4 ihu6un7/n s/tuen7/n /n7 l/in oleh -e6/t/n /nt/r sel. 6. Sel pem5entuk melanin ?el/nosit@ /t/u clear cell eru3//n selsel 6er8/rn/ u/4 en7/n sito3l/s/6/so;ili /n inti 7el/34
/n en7/nun7 6utir 3i7en ?melanosomes@. 2. Lapisan $ermis //l/h l/3is/n i 6/8/h e3ieris /n7 -/uh le6ih te6/l /ri3// e3ieris. '/3is/n ini teriri /t/s l/3is/n el/sti /n ;i6ros/ 3//t en7/n eleeneleen selul/r /n ;oliel r/6ut. Se5/r/7/ris 6es/r i6/7i en-/i u/ 6/7i/n /ni : Pars papilare4 /itu 6/7i/n /n7 enon-ol e e3ieris4 6erisi u-un7
ser/6ut s/r/; /n 3e6uluh /r/h Pars retikulare4 /itu 6/7i/n i 6/8/h /n7 enon-ol e /r/h su6ut/n4 6/7i/n ini teriri /t/s ser/6utser/6ut 3enun-/n7 is/ln/ ser/6ut ol/7en4 el/stin4 /n retiulin. D/s/r ?/tris@ l/3is/n ini
teriri /t/s 5/ir/n ent/l /s/ hi/luron/t /n onritin sul;/t4 i 6/7i/n ini ter/3/t 3ul/ ;i6ro6l/s. Ser/6ut ol/7en i6entu oleh ;i6ro6l/s4 e6entu i/t/n ?6une@ /n7 en7/nun7 hirosi3rolin /n hirosisilin. Kol/7en u/ 6ersi/t lentur en7/n 6ert/6/hn/ uur en-/i ur/n7 l/rut sehin77/ /in st/6il. Retiulin iri3 ol/7en u/. Ser/6ut el/stin 6i/s/n/ 6er7elo6/n74 6er6entu /or; /n u/h en7e6/n7 sert/ le6ih el/stis. . Lapisan su5kutis //l/h el/n-ut/n eris4 teriri /t/s -/rin7/n i/t lon77/r 6eris selsel le/ i/l/n/. Selsel le/ eru3/n sel 6ul/t4 6es/r4en7/n inti teres/ e 3in77ir sito3l/s/ le/ /n7 6ert/6/h. Sel sel ini e6entu elo3o /n7 i3is/h/n s/tu en7/n /n7 l/in oleh tr/6eul/ /n7 ;i6ros/. '/3is/n selsel le/ ise6ut 3/niulus /i3os/4 6er;un7si se6/7/i 5//n7/n //n/n. Di l/3is/n ini ter/3/t u-un7u-un7 s/r/; te3i4 3e6uluh /r/h4 /n 7et/h 6enin7. Te6/l ti3isn/ -/rin7/n le/ ti/ s// 6er7/ntun7 3// lo/lis/sin/. Di /6oen /3/t en5/3/i ete6/l/n 54 i /er/h elo3/ /t/ /n 3enis s/n7/t seiit. '/3is/n le/ ini -u7/ eru3//n 6/nt/l/n. E/sul/ris/si i ulit u/tur oleh 2 3lesus4 /itu 3lesus /n7 terlet/ i 6/7i/n /t/s eris ?3lesus su3er;isi/l@ /n /n7 terlet/ i su6utis ?3lesus 3ro;un/@. 3lesus /n7 i eris 6/7i/n /t/s en7///n /n/stoosis i 3/3il eris4 3lesus /n7 i su6utis /n i 3/rs retiul/re -u7/ en7///n /n/stoosis4 i 6/7i/n ini 3e6uluh /r/h 6eruur/n le6ih 6es/r. +er7/nen7/n en7/n 3e6uluh /r/h ter/3/t s/lur/n 7et/h 6enin7. -ISIOLO+I KULI!
/. Fun7si 3rotesi Kulit en-/7/ 6/7i/n /l/ tu6uh terh//3 7/n77u/n ;isis /t/u e/nis4 is/ln/ te/n/n4 7ese/n4 t/riin/4 7/n77u/n ii/8i4 terut// /n7 6ersi;/t irit/n. ontohn/ lisol4 /r6on4 /s/ /n /l/li u/t l/inn/. )/n77u/n /n7 6ersi;/t 3/n/s is/ln/4 r/i/si4 sen7/t/n sin/r ultr/ >iolet. )/n77u/n in;esi lu/r is/ln/ u/n4 6/teri4 /u3un -/ur. H/l i /t/s eun7in/n 6es/r /rn/ // 6/nt/l/n le/4te6/ln/ l/3is/n ulit /n ser/6ut ser/6ut -/rin7/n 3enun-/n7 /n7 6er3er/n se6/7/i 3elinun7 /ri 7/n77u/n ;isis. 6. Fun7si /6sors3si
Kulit /n7 seh/t ti/ u/h eres/3 /ir4 l/rut/n /n 6en/ 3//t.tet/3i 5/ir/n 7 u/h en7u/3 le6ih u/h i ser/34 6e7itu3un l/rut le/. ,ere/6ilit/s ulit terh//3 O24 /n o24/n u/3 /ir eun7in/n ulit iut en7/6il 6/7i/n /l/ ;un7si res3ir/si. Ke/3u/n /6so3r6si ulit i 3en7/ruhi oleh te6/l ti3isn/ ulit4 hir/si ele6/3/n4 et/6oloise /n -enis >ehiulu. ,ener/3/n /3/t 6erl/n7sun7 el/lui 5el/h /nt/r/ sel4ene6us sel e3ieris4 /t/u el/lui u/r/ s/lur/n elen-/r. Tet/3i le6ih 6/n/ /n7 el/lui sel e3ieris /ri 3// el/lui u/r/ elen-/r. 5. Fun7si esresi Kelen-/relen-/r ulit en7elu/r/n /t /n7 ti/ 6er7un/is/ et/6olis /l/ tu6uh 6eru3/ N/l4 ure/4 /s/ ur/t4 /n /oni/. Kelen-/r le/ 3// ;etus /t/s 3en7/ruh horone /nro7en /ri i6un/.e3rousi se6u untu elinun7i ulitn/ terh//3 5/ir/n /nion4 3// 8/tu l/hir i -u3/i se6/7/i >eriG 5/seos/. Se6u i 3rousi elinun7i ulit /ren/ l/3is/n se6u ini sel/in ein/i ulit -u7/ en/h/n e>/3ur/si /ir /n7 6erle6ih/n sehin77/ ulit ti/ en-/i erin7. . Fun7si 3erse3si . Kulit en7/nun7 u-un7u-un7 s/r/; sensoris i eris su6ulit. Terh//3 r/ns/n7/n 3/n/s i 3er/n/n oleh 6//n Ru;;ini i eris /n su6 utis. Terh//3 in7in i 3er/n/n oleh 6//n6//n Kr/use /n7 terlet/ i eris. +//n t/til eisner terlet/ i 3/3ill/ eris 6er3er/n terh//3 3er/6//n4 eii/n 3ul/ 3// 6//n erel ren>ier4 /n7 terlet/ i e3ieris. e. Fun7si 3en7/tur/n suhu tu6uh Kulit el/u/n 3er/n/n ini en7/n 5/r/ en7elu/r/n erin7/t /n en7erut/n otot 3e6uluh /r/h ulit. Kulit // //n 3e6uluh /r/h sehin77/ eun7in/n ulit en/3/t nutrisi /n7 5uu3 6/i. Tonus >/suler i 3en7/ruhi oleh s/r/; si3/tis . 3// 6/i 6i/s/n/ inin7 3e6uluh /r/h 6elu ter6entu se3urn/ sehin77/ ter-/i estr/ >/s/si 5/ir/n /rn/ itu ulit 6/i t/3/ le6ih ee/tos/ /rn/ le6ih 6/n/ en7/nun7 /ir /n N/. ;. Fun7si 3e6entu/n 3i7en Sel 3e6entu 3i7en 4 terlet/ i l/3is/n 6/s/l /n sel ini 6er/s/l /ri ri7il s/r/;. ,e6/nin7/n -ul/h sel 6/s/l el/nosit //l/h 10 : 1. *ul/h enosit/n -ul/h sert/ 6es/rn/ 6utir/n 3i7en. 7. Fun7si er/tin/si '/3is/n ulit or/n7 e8/s/ e3un/ -enis l/3is/n sel ut// /itu er/tinosit4 sel l/n7erh/ns4 el/nosit. Ker/tinosit i ul/i /ri sel 6/s/l /n7 en7///n 3e6el/h/n. Sel
6/s/l /n7 l/in //n 6er3in/ e /t/s /n 6eru6/h 6entu en-/i sel s3inosu4 /in e /t/s sel /in 7e3en7 /n 6er7r/nul/ en-/i sel 7r/nulosu. M/in l// inti en7hil/n7 4 /n er/tinosit ini en-/i sel t/nu /n7 /o;t4 3roses ini 6erl/nsun7 terus enerus seuur hiu34 /n s/3/i se/r/n7 6elu se3enuhn/ i et/hui. h.
Fun7si 3e6entu/n >it/in D Den7/n en7u6/h " ehirusi olesterol en7/n 3ertolon7/n sin/r /t/h/ri4 tet/3i
e6utuh/n tu6uh //n >it/in D //n 5uu3 ti/ 5uu3 h/n/ /ri h/l terse6ut sehin77/ 3e6eri/n >it/in D sistei /sih s/n7/t i 3erlu/n.
/% ipersensiti6itas 1% Reaksi tipe I Reaksi *epat
Dise6ut -u7/ re/si 5e3/t4 re/si /n;il/sis /t/u re/si /ler7i ien/l se6/7/i re/si /n7 se7er/ ti6ul sesu/h /le8r7en /su e /l/ tu6uh. Istil/h /ler7i /n7 3ert// /li i7un//n Eon ,iruet 3// t/hun 190( i/rti/n se6/7/i re/si 3e-/u /n7 6eru6/h 6il/ ter-/i ont/ en7/n 6/h/n /n7 s// untu eu/ /li /t/u le6ih. Anti7en /n7 /su /l/ tu6uh //n it/n7/3 oleh ;/7osit4 i3rosesn/ l/lu i3resent/se/n e sel Th 2. Sel /n7 /hirn/ ele3/s sitoin /n7 er/n7s/n7 sel + untu e6entu I7 &. I7 & //n ii/t oleh sel /n7 eilii rese3tor untu I7 & se3erti sel /st4 6/so;il /n eusino;il. +il/ tu6uh ter3/-/n7 ul/n7 en7/n /ler7en /n7 s//4 /ler7en /n7 /su i /l/ tu6uh 6//n ii/t oleh I7 M 3// 3eru//n sel /st /n7 eni6ul/n e7r/nul/si sel /st. De7r/nul/si terse6ut en7elu/r/n ei/tor /nt/r/ l/in hist/in /n7 i/3/t i /l/ 7r/nul7r/nul sel /n ini46ul/n 7e-/l/ 3// re/si hi3ersensiti>it/s ti3e I. ,en/it3en/it /n7 ti6ul se7er/ sesu/h tu6uh ter3/-/n7 en7/n /ler7en //l/h /s/ 6ron7hi/l4 rhinitis4 urti/ri/ /n er/titis /to3i. Dis/3in7 hist/in4 ei/tor l/in se3erti 3rost/7l/nin /n leuotrin ?SRSA@ /n7 ih/sil/n et/6olise /s/ /r/hion/t4 6er3er/n 3// ;/se l/6/t /ri re/si ti3e I /n7 serin7 ti6ul 6e6er/3/ -/ sesu/h ont/ en7/n /ler7en
/% Reaksi tipe II Reaksi sititoksik
Re/si ti3e II ise6ut -u7/ re/si sitotosi4 ter-/i oleh /ren/ i6entu /nti6oi -enis I7 ) /t/u I7 M terh//3 /nti7en /n7 eru3//n 6/7i/n sel 3e-/u. I/t/n /nti6oi
en7/n /nti7en /n7 eru3//n 6/7i/n /ri sel 3e-/u terse6ut /3/t en7/ti;/n o3leent /n eni6ul/n lisis. 'isis sel /3/t 3ul/ ter-/i el/lui sensit/si sel NK se6/7/i e;etor /nti6oi e3enentt sel sitotosisiti. ontoh re/si ti3e II //l/h estrusi sel /r/h er/h /i6/t re/si tr/ns;usi /n 3en/it /nei/ heoliti 3// 6/i /n7 6 /ru il/hir/n /n e8/s/. Se6/7io/n erus//n -/rin7/n 3// 3en/it /uto iun se3erti i/steni/ 7r/>is /n tirotosiosis -u7/ iti6ul/n el/lui e/nise re/si ti3e II. Anei/ heoliti /3/t iti6ul/n oleh o6/t se3erti 3enisilin4 inin /n sul;on/i.
"% Reaksi tipe III atau reaksi kompleks imun
Re/si ti3e III /t/u re/si o3les iun ter-/i /i6/t en/3/n o3les /nti7en /nti6oi /l/ -/rin7/n /t/u 3e6uluh /r/h. Anti6oi isini 6i/s/n/ -enis I7 ) /t/u I7 M. Ko3les terse6ut en7/ti;/n o3leent /n7 eui/n ele3/s 6er6/7/i ei/tor terut// /5ro3h/7e 5heot/5ti5 ;/5tor. M/ro;/7 /n7 ier/h/n e te3/t terse6ut //n erus/ -/rin7/n seit/r te3/t terse6ut. Anti7en /3/t 6er/s/l /ri in;esi u/n 3/to7en /n7 3ersisten ?/l/ri/@4 6/h/n /n7 terhiru3 ?s3or/ -/ur /n7 eni6ul/n /l>eolitis estrinsi /ler7i@ /t/u -/rin7/n seniri ?3en/it /utoiun@. In;esi terse6ut isert/i en7/n /nti7en /l/ -ul/h /n7 6erle6ih/n4 tet/3i ti/ isert/i en7/n res3on /nti6oi e;eti;. Anti7en ?A7@ /n /nti6oi ?A6@ 6ers/tu e6entu o3les iun. Sel/n-utn/ o3les iun en7/ti/n /n7 ele3/s / /n %/ /n er/n7s/n7 6/so;il /n tro6osit ele3/s 6er6/7/i ei/tor /nt/r/ l/in hist/in /n7 en7i/t 3ere/6ilit/s >/sul/r. D/l/ e///n nor/l o3les iun iusn/h/n oleh sel ;/7osit ononule/r terut// /l/ h/ti4 li;/ /n 3/ru t/n3/ 6/ntu/n o3leen. D/l/ 3roses terse6ut4 uur/n o3les iun eru3//n ;/tor 3entin7. ,// uun/ o3les /n7 6es/r4 u/h /n 5e3/t iusn/h/n /l/ h/ti. Ko3les /n7 l/rut ter-/i 6il/ /nti7en iteu/n -/uh le6ih 6/n/ /ri 3// /nti6oi /n7 sulit untu iusn/h/n /n oleh /ren/ itu /3/t le6ih l// // /l/ sirul/si. Ko3le iun /n7 // //l sirul/si esi3un /l/ 8/tu /n7 l//4 6i/s/n/ ti/ 6er6/h//. ,er/s/l/h/n //n ti6ul 6il/ o3les iun ene6us inin7 3e6uluh /r/h /n en7en/3 i -/rin7/n. )/n77u/n ;un7si ;/7osit ii7/ /3/t eru3//n se6/6 en7/3/ o3les iun sulit iusn/h/n.
4% Reaksi !ipe I. Reaksi (ipersensiti6itas lam5at
Re/si ti3e IE /n7 -u7/ ise6ut re/si hi3ersensiti>it/s l/6/t4 ti6ul /ri 2# -/ setel/h tu6uh ter3/-/n7 en7/n /nti7en. De8/s/ ini4 re/si ti3e IE i6/7i /l/ el/e ti3e
hi3ersensiti>iti /n7 ter-/i el/lui D # /n T 5ell ei/te sitolisis /n7 ter-/i el/lui sel D $. ,// Del/e T3e H3ersensiti>it sel D # /n7 en7/tio;/n /ro;/7 6er3er/n se6/7/i sel e;etor. D # Th 1 ele3/s sitoin ?IFN
γ
@ /n7 en7/ti;/n /ro;/7 /n
en7inusi in;l//si. ontoh5ontoh re/si DTH //l/h se6/7/i 6eriut: 1@ Re/si tu6erulin/itu re/si er/l /n7 6er6e/ en7/n re/si er/titis ont/ /n7 ter-/i 20 -/ setel/h ter3/-/n7 en7/n /nti7en. Re/si teriri /t/s in;iltr/si sel ononule/r ?%0=@ //l/h li;osit /n sis/n/ osnosit. 2@ Der/titis ont/. Re/si DTH /3/t ter-/i se6/7/i res3on terh//3 6/h/n /n7 ti/ 6er6/h// /l/ lin7un7/n se3erti niel /n7 eni6ul/n er/titis ont/ sel l/n7erh/ns se6/7/i /nti7en 3resentin7 sel /t/u A,4 sel Th 1 /n /ro;/7 ee7/n7 3er/n/n 3// re/si terse6ut. @ Re/si 7r/nulo/ 3// e///n /n7 3/lin7 en7untun7/n DTH 6er/hir en7/n h/n5urn/ iroor7/nise oleh eni lisoso /n 3rou /ro;/7 l/inn/ se3erti terosit r/i/l /n su3erosi. T ell Meei/te tolisis. D/l/ erus//n ter-/i el/lui D $ B sitotosis T l3o5ite ?T'BT5@ /n7 l/n7sun7 e6unuh sel s/s/r/n. ,en/ih hi3ersensiti>it/s selul/r isu7/ eru3//n se6/6 /uto iunit/s. Oleh /ren/ itu4 3en/it /n7 iti6ul/n h3ersensiti>it/s selul/r 5enerun7 ter6/t/s e3// 6e6er/3/ or7/n s/-/ /n 6i/s/n/ ti/ sistei. ,// 3en/it >irus he3/titis4 >irus seniri ti/ sito3/ti4 tet/3i erus//n iti6ul/n oleh res3on T' terh//3 he3/tosit /n7 terin;esi.
Sel D $ s3esi;i untu /nti7en /t/u sel /utolo7us /3/t e6unuh sel en7/n l/n7sun7. ,// 6/n/ 3en/it /utoiun /n7 ter-/si el/lui e/nise selul/r4 6i/s/n/ iteu/n 6/i sel D # /u3un D $ s3esi;i sel; /nti7en /n eu/ -enis sel terse6ut /3/t eni6ul/n erus//n.
"% DI-E,!IAL DIA+,OSIS
,o
+e7ala klinis
DKA
DKI
UR!IKARIA
1
!/nit/ 20 t/hun
2
+er5/ er/h 6er6/t/s te7/s i 3er7el/n7/n t/n7/n
H/n7/t 3// 3er/6//n
#
)/t/l
%
Ti/ // neri 3ene/n/n
(
K/6uh/n setel/h en5u5i
B
B
"
'o/si isel/2 -/ri t/n7/n /n /i
4% DERMA!I!IS KO,!AK ALER+I EPIDEMIOLO+I
+il/ i6/nin7/n en7/n DKI4-ul/h 3enerit/ DKA le6ih seiit /ren/ h/n/ en7en/i or/n7 /n7 e///n ulitn/ s/n7/t 3e/ ?h3ersensit>it@.ir//l/n 6/h8/ -ul/h DKA /u3un DKI /in 6ert/6/h seirin7 en7/n 6ert/6/hn/ -ul/h 3rou /n7 en7/nun7 6/h/n ii/ /n7 i3//i oleh /s/r//t.n/un in;or/si en7en/i 3re>/lensi /n insien DKA i /s/r//t s/n7/t seiit4sehin77/ 6er/3/ /n7/ /n7 ene/ti e6en/r/n 6elu i/3/t. D/hulu i3erir//n 6/h8/ e-/i//n DKI /i6/t er-/ se6/n/ $0= /n DKA 20=4tet/3$i /t/ 6/ru /ri in77ris /n AS enun-u/n 6/h8/ er/titis ont/ /i6/t er-/ /ren/ /ler7i tern/t/ 5uu3 tin77i /itu 6eris/r /nt/r/ %0 /n (0=.Se/n7/n s/tu 3eneliti/n eneu/n ;reuensi DKA 6u/n i/i6/t/n er-/ h/ri le6ih serin7 /ri3// DKA /i6/t er-/. E!IOLO+I ,ene6/6 DKA //l/h 6/h/n ii/ seerh/n/ en7/n 6er/t oleul uun/
ren/h ?J1000 /lton@4eru3/n /ler7en /n7 6elu i3roses4ise6ut h/3ten46ersi;/t li3o;ili4s/n7/t re/ti;4/3/t ene6us str/tu orneu sehin77/ en5/3/i sel e3ieris i 6/8/hn/ ?sel hiu3@.+er6/7/i ;/tor 3en7/ruh /l/ ti6uln/ DKA4is/ln/43otensi sensitis/si /ler7en4osis 3er unit /re/4 lu/s /er/h /n7 teren/ 4l// 3/-/n/n4 olusi4 suhu /n ele6/6/n lin7un7/n4sehiulu4/n 3H.*u7/ ;/tor ini>iu4is/ln/ e///n ulit 3// lo/si ont/ ?e///n str/tu orneu4ete6/l/n e3ieris@4st/tus iunolo7i ?is/ln/ se/n7 enerit/ s/it4ter3/-/n sin/r /t/h/ri@. PA!OMEKA,ISME
Me/nise ter-/in/ el/in/n ulit 3// DKA //l/h en7iuti res3on iun /n7 i3er/nt/r/i oleh sel /t/u re/si iunolo7i ti3e IE4 su/tu hi3ersensiti>it/s ti3e l/6/t.
Re/si ini ter-/i el/lui u/ ;/se4 /itu ;/se sensit/si /n ;/se elisit/si. H/n/ ini>iu /n7 en7/l/i sensit/si /3/t enerit/ DKA.
a% -ase Sensitisasi
H/3ten /n7 /s e/l/ e3ieris ele8/ti str/tu orneu //n i t/n7/3 oleh sel l/n7erh/ns en7/n 5/r/ 3inositosis4 /t/u i3roses se5/r/ ii/8i oleh eni lisoso /t/u sitosol sert/ i on-u7/si/n 3// oleul H'ADR en-/i /nti7en len7/3. ,// /8/ln/ sel l/n7erh/ns /l/ e///n istir/h/t4 /n h/n/ 6er;un7si se6/7/i /ro;/7 /n7/n seiit e/3u/n enstiul/si sel T. Tet/3i4 setel/h re/tinosit ter3/-/n oleh h/3ten -u7/ e3un/i si;/t irit/n4 //n ele3/s/n sitoin /n7 //n en7/ti;/n sel l/n7erh/ns sehin77/ /3u enstiul/si sel T. Ati>/si terse6ut //n en7u6/h ;enoti3 sel l/n7erh/ns /n enin7/t/n seresi sitoin tertentu sert/ es3resi oleul 3eru//n sel ter/su MH el/s 1 /n 24 IAM14 'FA4 /n +". Sitoin 3ro in;l//si l/in /n7 ile3/s/n oleh er/tinosit /itu TNF 4 /n7 /3/t en7/ti;/si sel T 4 /ro;/7 /n 7r/nulosit 4 en7inusi 3eru6/h/n oleul /hesi sel /n 3ele3/s/n sitoin -u7/ enin7/t//n MH el/s 1 /n 2. TNF Mene/n 3rousi &5/herin /n7 en7i/t sel '/n7erh/ns 3// e3ieris4 -u7/ en7inusi /ti>it/s )el/tinolisis sehin77/ e3erl/n5/r sel l/n7erh/ns le8/ti e6r/n +/s/lis 6eri7r/si e elen-/r 7et/h 6enin7 sete3/t el/lui s/lur/n li;e. Di/l/ elen-/r 'i;e sel l/n7erh/ns e3ersent/se/n o3les H'ADR /nti7en e3// sel T 3enolon7 s3esi;i4 /itu /n7 en7es3resi/n oleul D# /n7 en7en/li H'ADR sel l/n7erh/ns 4 /n o3les rese3tor sel T D /n7 en7en/li /nti7en /n7 tel/h i3roses. A/ /t/u ti/ //n/ sel T s3esi;i itentu/n se5/r/ )eneti. Sel l/n7erh/ns enseresi I'1 /n7 enstiul/si untu ensesresi I'2 4 D/n en7es3resei/n rese3tor I'24 Sitoin ini //n enstiul/si 3roli;er/si sel T S3esi;i4 senhin77/ en-/i le6ih 6/n/. Turun/n sel ini /itu sel T eori //n enin77/l/n elen-/r 7et/h 6enin7 /n 6ere/r eseluruh tu6uh. ,// s//t terse6ut ini>iu en-/i tersensitis/si. F/se ini r/t/r/t/ 6erl/n7sun7 sel// 2 in77u. Menurut onse3 L/n7er si7n/l
6/h8/ si7n/l /nti7eni5 urni su/tu h/3ten
5enerun7 ene6/6/n toler/nsi 4 se/n7/n sin/l irit/nn/ eni6ul/n sensitis/si. Den7/n eii/n ter-/in/ sensitis/si ont/ 6er7/ntun7 3// //n/ sin/l irit/n /n7 /3/t 6er/s/l /ri /ller7en ont/ seniri4 /ri /6/n7 r/n7s/n7 /n7 ren/h terh//3 res3on irit/n 4 /ri 6/h/n ii/ in;//si 3// ulit/ /n7 er//n7 /t/u o6in/si /ri eti7/n/.
5% -ase Elisitasi
F/se eu/ //l/h elisit/si Hi3ersensiti>it/s ti3e l/6/t er-/i 3// 3/-/n/n ul/n7 /ller7en se3erti 3// ;/se sensitis/si 4 h/3ten //n it/n7/3 oleh sel l/n7erh/ns /n i3roes se5/r/ ii/8i en-/i /nti7en4 ii/t oleh H'ADR eui/n ie3resi/n i3eru//n sel. Sel/n-utn/ o3les H'ADR /nti7en //n i3resent/se/n e3// sel T /n7 tel/h tersensitis/ssi 6/i iulit /u3un ielen-/r li;e4 sehin77/ ter-/i 3roses /ti>/si. Diulit 3roses /ti>/si le6ih o3les en7/n h/irn/ selsel l/in. Sel l/n7erh/ns enseresi I'1 /n7 enstiul/si sel T untu e3rousi I'24 /n en7ess3resi I'2R4 /n7 //n ene6/6/n 3roli;er/si /n es3/nsi 3o3ul/si sel T iulit. Sel T ter/ti>/si -u7/ en7elu/r/ IFN /n7 //n en7/ti;/n er/tinosit en7es3resi IAM1 D/n H'A DR //n/ IAM1 Meun7in/n er/tinosit untu 6erinter/si en7/n sel T4 /n 'euosit /n7 l/in /n7 en7es3resi oleul 'FA1 . se/n7/n H'ADR eun7in/n er/tinosit untu 6erinter/si l/n7sun7 en7/n sel T D# 4 /n -u7/ eun7in/n 3resent/se /nti7en e3// sel terse6ut. H'ADR *u7/ /3/t eru3//n t/r7et sel T sitotosi 3// er/tinosit. Ker/tinosit en7h/sil/ se-ul/h sitoin /nt/r/ I'1 4 I'(4 TNF 4 /n )MSF4 seu/n/ /3/t en7/ti>/si sel T . I'1 /3/t enstiul/si er/tinosit en7h/sil/n eios/noi. sitoin /n eios/nio //n en7/ti;/n sell /ss /n /ro;/7. Sel /ss /n7 6er// i e/t 3e6uluh /r/h eris //n ele3/s/n /nt/r/ l/in hist/ine4 6er6/7/i -enis ;/5tor eot/ti4 ,)&2 /n ,)D24 /n leuotrin +#. &ios/noi 6/i /n7 6er/s/l /ri sel /s /u3un /ri er/tinosit /t/u leuosit ene6/6/n il/t/si >/s5ul/r /n enin7/t/n 3ere/6ilit/s sehin77/ oleul l/rut se3erti o3leen /n inin u/h 6eri;usi e /l/ eris /n e3ieris. Sel/in itu ;/5tor eot/ti /n eios/noi //n en/ri neutro;il4 onosit /n sel /r/h l/in /ri /l/ 3e6uluh /r/h /su /l/ eris. Rentet/n e-/i/n terse6ut //n eni6ul/n res3ons lini DKA. F/se elisit/si uun/ 6erl/n7sun7 /nt/r/ 2##$ -/. +E2ALA KLI,IS
,enerit/ uun/ en7eluh 7/t/l. Kel/in/n ulit 6er7/ntun7 3// e3/r/h/n er/titis /n lo/lis/sin/. ,// /n7 /ut iu/i en7/n 6er5/ erite/tos/ /n7 n6er6/t/s -el/s eui/n iiuti ee/4 3/3ulo >esiel4 >esiel /t/u 6ul/. Eesiel /t/u 6ul/ /3/t 3e5/h eni6ul/n erosi /n esu/si. DKA /ut i te3/t tertentu is/ln/ elo3/ /t/4 3enis4 srotu4 erite/ /n ee/ le6ih oin/n /ri3// >esiel. ,// /n7 tonis terlih/t ulit erin7 6ersu//4 3/3ul4 lieni;i/si /n un7in -u7/ ;isur4 6/t/sn/ ti/
-el/s. Kel/in/n ini sulit i6e//n en7/n Der/titis ont/ irit/n ronis /n7 un7in 3ene6/6n/ -u7/ 5/3ur/n. DKA D/3/t elu/s ete3/t l/in4 is/ln/ en7/n 5/r/ /utosensitis/si s/l34 tel/3/ t/n7/n /n /i rel/ti; resisten terh//3 DKA. DIA+,OSIS
Di/7nosis i /s/r/n /t/s h/sil /n/nesis /n7 5er/t /n 3eeris//n linis /n7 teliti. ,ert/n//n en7en/i ont/t/n /n7 i5uri7/i i/s/r/n el/in/n ulit /n7 iteu/n.is/ln/4// el/in/n ulit /n7 6eruur/n nuul/r i seit/r u6ili5us 6eru3/ hi3er3i7ent/si4lieni>i/si4en7/n 3/3ul /n erosi4// 3erlu it/n//n /3//h 3enerit/ e//i /n5in7 5el/n/ /t/u e3/l/ i/t 3in77/n7 /n7 ter6u/t /ri lo7/?niel@./t/ /n7 6er/s/l /ri /n/nesis -u7/ eli3uti ri8//t 3eer-//n4ho6i4o6/t to3i5/l /n7 3ern/h i7un//n4o6/t sistei4oseti/46/h/n6/h/n /n7 iet/hui eni6ul/n /ler7i43en/it ulit /n7 3ern/h i/l/i4ri8//t /to3i46/i /ri /n7 6ers/n7ut/n /u3un elu/r7/n/. ,eeris//n ;isis s/n7/t 3entin74/ren/ en7/n elih/t lo/si /n 3ol/ el/in/n ulit serin7 /li
/3/t
iet/hui
eoor/nt4i3er7el/n7/n
eun7in/n
t/n7/n4oleh
-/
3ene6/6n/4is/ln/4ieti/ t/n7/n4ieu/
/i
oleh
se3/tu
oleh /t/u
s/n/l.3eeris//n hen/n/ il/u/n i te3/t /n7 5uu3 ter/n743// seluruh ulit untu elih/t eun7in/n el/in/n ulit l/in /rn/ se6/6se6/6 eno7en.
PEMERIKSAA, PE,U,2A,+
Untu e/sti/ i/7nosis // i3erlu/n 3eeris//n 3enun-/n74 s/l/h s/tu 3eeris//n /n7 il/u/n /itu U-i Te3el. Untu el/u/n u-i te3le i3erlu/n /nti7en46i/s/n/ /nti7en st/n/r 6u/t/n 3/6ri4is/ln/ ;inn 5h/6er sste it /n.T.R.U.&.6/h/n /n7 i7un//n untu u-i te3le is/ln/ oseti 3ele6/643rou /n7 iet/hui 6ersi;/t irit/n is/ln/ eter-en4h/n/ 6oleh iu-i 6il/ iu7/ er/s 3ene6/6 /ler7i 3erlu i in7/t 6/h8/ h/sil 3ositi; en7/n /ller7en 6u/n st/n/r 3erlu 5ontrol ?%10 or/n7@4untu enin7ir/n eun7in/n /rn/ irit/si. U-i te3el 6i/s/ il/u/n sel// #$ -/ setel/h itu u-i te3elile3/s.3e6/5//n 3ert// il/u/n 1%0 enit setel/h ile3/s4 /7/r e;e te/n/n 6/h/n /n7 i u-i tel/h en7hil/n7 /t/u ini/l.h/siln/ se6/7/i 6eriut: •
1 re/si le/h ?non >esi5ul/r@: erite/4in;iltr/te43/3ul ?@
• • • • • • •
2 re/si u/t:ee/ /t/u >esiel ?@ re/si s/n7/t u/t ?estri@: 6ul/ /t/u ulus ?@ # er/7u/n:h/n/ /5ul/ erite/tos/ % irit/si: se3erti ter6//r43ustule /t/u 3ur3ur/ ?ir@ ( re/si ne7/ti>e ?@ " eG5ite sin $ ti/ i tes ?NTnot teste@
untu en7inter3ret/si h/sil u-i te3le ti/ u/h.res3on /ler7i 6i/s/n/ en-/i le6ih -el/s /nt/r/ 3e6/5//n e s/tu /n eu/46er/8/l /ri B e /t/u 6/h/n e se/n7/n res3on irit/n 5enerun7 enurun. Re/si 3ositi; 3/lsu /3/t ter-/i 6il/ onsentr/si terl/lu tin77i4/t/u 6/h/n terse6ut 6ersi;/t irit/n 6il/ /l/ e///n tertutu3 ini ise6/6/n /ren/ e;e te/n4ter-/i 6il/ en77un//n 6/h/n 3//t. Re/si ne7/ti>e 3/lsu /3/t ter-/i is/ln/ onsentr/si terl/lu ren/h4>ehiulu ti/ te3/t46/h/n u-i te3el ti/ ele/t en7/n 6/i4/t/u lon77/r /i6/t 3er7er//n4ur/n7 5uu3 8/tu 3en7henti/n 3e//i/n ortiosteroi sistei /t/u to3i5/l 3oten /n7 l// i3//i 3// /re/ u-i te3le il/u/n.
PE,A!ALAKSA,AA, 8Pen*ega(an $an Pengo5atan9 H/l /n7 3erlu i 3erh/ti/n 3// 3en7o6/t/n er/titis ont/ e6/li en7/n
/ller7en 3ene6/64 /n ene/n el/in/n ulit /n7 ti6ul. Kortiosteroi /3/t i6eri/n /l/ -/n7/ 3ene untu en7/t/si 3er//n7/n 3// DKA /ut /n7 i t/n/i en7/n erite/4ee/4>esiel
/t/u
6ul/4sert/
esi/ti;
?/i/ns@4is/ln/
3renisone
07Bh/ri.uun/ el/in/n ulit //n ere/ setel/h 6e6er/3/ h/ri.se/n7/n el/in/n ulitn/ 5uu3 i o3res en7/n l/rut/n 7/r/ ;//l /t/u l/rut/n /ir s/lisil 1:1000.
PRO+,OSIS ,ro7nosis DKA uun/ 6/i4se-/uh 6/h/n ont/n/ /3/t isin7ir/n.3ro7nosis
ur/n7 6/i /n en-/i ronis 6il/ ter-/i 6ers///n en7/n er/titis oleh ;/5tor eno7en ?er/titis /to3i54er/titis nuul/ris4/t/u 3sori/sis@4/t/u ter3/-/n oleh /ller7en /n7 ti/ un7in ihin/ri4is/ln/ 6erhu6un7/n en7/ 3eer-//n tertentu /t/u /n7 ter/3/t lin7un7/n 3enerit/.
% DERMA!I!IS KO,!AK IRIR!A,
EPIDEMIOLO+I Der/titis ont/ irit/n /3/t ierit/ oleh seu/ or/n7 /ri 6er6/7/i 7olon7/n uur4r/s /n -enis el/in. *ul/h 3enenerit/ DKI e3erir//n 5uu3 6/n/4terut// /n7 6erhu6un7/n en7/n 3eer-//n ?DKI /i6/t er-/@ n/un /n7/n/ se5/r/ te3/t sulit iet/hui4h/l ini ise6/6/n /nt/r/ l/in oleh 6/n/ 3enerit/ en7/n el/in/n rin7/n ti/ /t/n7 6ero6/t /t/u 6/h/n ti/ /t/n7 en7eluh. E!IOLO+I ,ene6/6 un5uln/ er/titis -enis ini i/l/h 6/h/n /n7 6ersi;/t irit/n4 is/ln/ 6/h/n
3el/rut4 eter7en4 in/ 3elu/s4 /s/ /l/li /n ser6u /u. Kel/in/n ulit /n7 ter-/i sel/in itentu/n oleh uur/n oleul4 // l/rut4 onsentr/si 6/h/n terse6ut /n >ehiulu -u7/ i3en7/ruhi oleh ;/tor l/in. F/tor /n7 i/su /itu: l// ont/4 eer/3/n ?terus enerus /t/u 6ersel/n7@4 //n/ olusi ene6/6/n ulit le6ih 3ere/6le4 eii/n 3ul/ 7ese/n /n tr/u/ ;isis. Suhu /n ele6/6/n -u7/ iut 6er3er/n. F/tor ini>iu -u7/ iut 6er3en7/ruh 3// DKI4 is/ln/ 3er6e//n ete6/l/n ulit i 6er6/7/i te3/t ene6/6/n 3er6e//n 3ere/6ilit/s4 usi/ ?/n/ i6/8/h $ t/hun /n usi/ l/n-ut le6ih u/h teririt/si@4 r/s ?ulit hit/ le6ih t/h/n i6/nin7 ulit 3utih@4 -enis el/in ? insien DKI le6ih 6/n/ 3// 8/nit/@4 3en/it ulit /n7 3ern/h /t/u se/n7 i/l/i ?/6/n7 r/n7s/n7 terh//3 6/h/n irit/n enurun@4 is/ln/ er/titis /to3i.
PA!OMEKA,ISME
Kel/in/n ulit /i6/t erus//n sel /n7 i se6/6/n /ren/ 6/h/n irit/n el/lui er-/ ii/8i /t/u ;isis. +/h/n irit/n erus/ l/3is/n t/nu4 en/tur/si er/tin4 enin7ir/n le/ l/3is/n t/nu4 /n en7u6/h // i/t /ir ulit. Ke6/n//n 6/h/n irit/n /t/u tosin erus/ e6r/ne le/ er/tinosit4 tet/3i se6/7i/n /3/t ene6us e6r/ne sel /n erus/ lisoso4 itoonri/4 /t/u o3onen inti. Kerus//n e6r/ne en7/ti;/n ;os;oli;/se /n ele3/s/n /s/ /r/ion/t4 i/sil7liseri/4 3l/telet /5ti>/tin7 ;/5tor /n inositi/. AA i ru6/h en-/i 3rost/7l/nin /n leuotrin. ,) /n 'T en7inusi >/soil/t/si4 /n enin7/t/n 3ere/6ilit/s >/suler sehin77/ e3eu/h tr/nssu/si o3leen /n inin. ,) /n 'T -u7/ 6ertin/ se6/7/i eo/tr/t/n u/t untu li3sit /n neutro;il4 sert/ en7/i;/si sel /s ele3/s/n hist/ine 'T /n ,) '/in4 /n ,AF4 sehin77/ e3eru/t 3eru6/h/n >/s5ul/r. DA) /n se5on essen7er l/in enstiul/si es3resi 7en /n sintesis 3rotein4 is/ln/ interleuin1 /n 7r/nulo5te /5hro3h/7e 5olon stiul/tuns; ;/5tor. I' 1 en7/ti;/n sel T 3enolon7 en7elu/r/n I' 2 /n en7es3resi rese3tor I' 24 /n7 eni6ul/n stiul/si /utorin /n 3roli;er/si sel
terse6ut. Kre/tinosit e6u/t oleul 3eru//n H'ADR /n /hesi intr/ sel 1. ,// ont/ en7/n irit/n4 er/tinosit -u7/ ele3/s/n TNF 4 su/tu sitoin 3roin;l//si /n7 /3/t en7/i;/n sel T4 /ro;/7 /n 7r/nulosit en7inusi es3resi oleul /hesi sel /n 3ele3/s/n sitoin. +E2ALA KLI,IS Kel/in/n ulit /n7 ter-/i s/n7/t 6er/7/4 6er7/ntun7 3// si;/t irit/n. Irit/n u/t e6eri 7e-/l/ /ut se/n7 irit/n le/h e6eri 7e-/l/ ronis. Sel/in itu -u7/ 6/n/ ;/tor /n7 e3en7/ruihi se6/7/i /n/ /n7 tel/h i se6ut//n /itu ;/tor ini>iu ?is/ln/ r/s4 usi/4 lo/si4 /to3i4 3en/it ulit l/in@4 ;/tor lin7un7/n ?is/ln/ suhu /n ele6/6/n u/r/4 olusi@. +er/sr/n 3ene6/6 /n 3en7/ruh ;/tor;/tor terse6ut // /n7 en7lisi;i/si DKI en-/i 10 /5/ /itu : DKI /ut4 l/6/t /ut ?/ut el/e ID@4 re/si irit/n4 uul/ti;4 tr/u/ ter/ti;4 esi/si ee//ti4 3ush tuler /n /7ne;oris4 nonerite/tos/ /n su6eti;. A/ 3ul/ /n7 e6/7i 2 /te7ori /itu /te7ori /oor teriri /t/s DKI /ut ter/su lu/ 6//r ii/8i4 /n DKI uul/ti;. K/te7ori l/in teriri /t/s : DKI l/6/t /ut4 re/si irit/si4 DKI tr/u/ti DKI erite/tos/4 /n DKI su6eti;.
*% DKI akut
'u/ 6//r oleh 6/h/n i/ -u7/ ter/su er/titis ont/ irit/n /ut. ,ene6/6 DKI /ut //l/h irit/n u/t4 is/ln/ l/rut/n /s/ sul;/t /n /s/ hirolori/ /t/u 6/s/ u/t4 is/ln/ n/triu /n /liuhirossi/. +is/n/ ter-/i /i6/t e5el///n /n re/si se7er/ ti6ul. Intensit/s re/si se6/nin7 en7/n onsentr/si /n l/n/ ont/ en7/n irit/n ter6/t/s 3// ont/ te3/t ulit ter/s/ 3eih4 3/n/s4 r/s/ ter6//r4 el/in/n /n7 terlih/t 6eru3/ erite/ ee/4 6ull/4 unin -u7/ 6is/ nerosis. ,in77ir el/in/n ulit 6er6/t/s te7/s /n 3// uun/ /sietris
$% DKI akut lam5at
)/6/r/n linis /n 7e-/l/ s// en7/n DKI /ut tet/3i4 6/ru u5ul $2# -/ /t/u setel/h ont/. +/h/n irit/n /n7 /3/t ene6/6/n irit/n /n /3/t ene6/6/n DKI /ut l/6/t4 is/ln/ 3eo;ilin4 /ntr/lin4 tretinoin4 etilen osi/4 6en/loniu lori/ /s/ hiro ;lur/t.5ontohn/ //l/h er/titis /n7 i se6/6/n oleh 6ulu ser/n77/ /n7 ter6/n7 3// /l/ h/ri ? er/titis >enen/t/@ 3enerit/ 6/ru er/s/ 3eih eso h/rin/4 3// /8/ln/ terlih/t erite/4 /n soe h/rin/ su/h en-/i >esuel /t/u 6/h/n nerosis.
e% DKI kumulati'
*enis er/titis ont/ ini 3/lin7 serin7 ter-/i4 n// l/in i/l/h DKI ronis 3ene6n/ //l/h ont/ 6erul/nul/n7 en7/n irit/n le/h ?;/tor ;isis4 is/ln/ 7ese/n4 tr/u/ iro4 ele6/6/n ren/h4 3/n/s /t/u in7in4 -u7/ 6/h/n is/nln/ eter7en4 s/6un4 3el/rut4 t/n/h4 6/h/n -u7/ /ir@. DKI uul/ti; un7in ter-/i /ren/ er-/ s// 6er6/7/i ;/tor. +is/ -/i su/tu 6/h/n se5/r/ seniri ti/ 5uu3 u/t ene6/6/n er/titis irit/n4 tet/3i 6/ru /3u 6er7/6un7 en7/n ;/tor l/in. Kel/in/n 6/ru n/t/ setel/h ont/ 6erin77uin77u /t/u 6ul/n /t/u 6is/ 6ert/hunt/hun eui/n4 sehin77/ 8/tu rentet/n ont/ eru3//n ;/tor 3entin7 )e-/l/
l/si 6eru3/
ulit
erin74erite/4su//
l/6/t
l/un ulit
te6/l
?h3erere/tosis@/n 'ieni;i/si4i;us.6il/ ont/ terus 6erl/n7sun7 /hirn/ ulit /3/t ret/ ?>isur@4is/ln/ 3// lit tuit tu/n7 5u5i /n7 en7/l/i ont/ terusenerus en7/n eter7en4en7/n eter7en.eluh/n C3enerit/ uun/ r/s/ 7/t/l /t/u neri /ren/ ulit ret/ ?>isur@4// /l/n/ el/in/n h/n/ 6eru3/ ulit erin7 /t/u su// t/n3/ erite/4senhin77/ i/6/i/n oleh 3enerit/.setel/h ir/s//n en77/n77u46/ru en/3/t 3erh/ti/n. DKI oul/ti; serin7 6erhu6un7/n en7/n 3eer-//n4oleh /ren/ itu 6/n/ iteu/n it/n7/n i 6/nin7/n i 6/7i/n l/in tu6uh.5ontoh 3eer-//n /n7 6erisio tin77i untu DKI oul/ti; /itu : tu/n7 5u5i4uli 6/n7un/n4ontir i 6en7el4-uru /s/4tu/n7 e6un43en/t/ r/6ut.
DIA+,OSIS
Di/7nosis DKI 6er/s/r/n /n/nesis /n7 5er/t /n 3en7//t/n 7/6/r/n linis.DKI /ut le6ih u/h i et/hu/ /rn/ un5uln/ le6ih 5e3/t sehin77/ 3enerit/ 3// uun/ /sih in7/t /3/ /n7 en-/i 3ene6/6n/.se6/lin/4DKI ronis ti6uln/ l/6/t sert/ e3un/ >/ri/si 7/6/r/n linis /n7 lu/s4sehin77/ // /l/n/ sulit i6e//n en7/n er/titis ont/ /ler7i.untu ini i3erlu/n u-i te3le en7/n 6/h/n /n7 i 5uri7/i. PEMERIKSAA, PE,U,2A,+
Untu e/sti/ i/7nosis // i3erlu/n 3eeris//n 3enun-/n74 s/l/h s/tu 3eeris//n /n7 il/u/n /itu U-i Te3el.
Untu el/u/n u-i te3le i3erlu/n /nti7en46i/s/n/ /nti7en st/n/r 6u/t/n 3/6ri4is/ln/ ;inn 5h/6er sste it /n.T.R.U.&.6/h/n /n7 i7un//n untu u-i te3le is/ln/ oseti 3ele6/643rou /n7 iet/hui 6ersi;/t irit/n is/ln/ eter-en4h/n/ 6oleh iu-i 6il/ iu7/ er/s 3ene6/6 /ler7i 3erlu i in7/t 6/h8/ h/sil 3ositi; en7/n /ller7en 6u/n st/n/r 3erlu 5ontrol ?%10 or/n7@4untu enin7ir/n eun7in/n /rn/ irit/si. U-i te3el 6i/s/ il/u/n sel// #$ -/ setel/h itu u-i te3elile3/s.3e6/5//n 3ert// il/u/n 1%0 enit setel/h ile3/s4 /7/r e;e te/n/n 6/h/n /n7 i u-i tel/h en7hil/n7 /t/u ini/l.h/siln/ se6/7/i 6eriut: • • • • • • • •
1 re/si le/h ?non >esi5ul/r@: erite/4in;iltr/te43/3ul ?@ 2 re/si u/t:ee/ /t/u >esiel ?@ re/si s/n7/t u/t ?estri@: 6ul/ /t/u ulus ?@ # er/7u/n:h/n/ /5ul/ erite/tos/ % irit/si: se3erti ter6//r43ustule /t/u 3ur3ur/ ?ir@ ( re/si ne7/ti>e ?@ " eG5ite sin $ ti/ i tes ?NTnot teste@
untu en7inter3ret/si h/sil u-i te3le ti/ u/h.res3on /ler7i 6i/s/n/ en-/i le6ih -el/s /nt/r/ 3e6/5//n e s/tu /n eu/46er/8/l /ri B e /t/u 6/h/n e se/n7/n res3on irit/n 5enerun7 enurun. Re/si 3ositi; 3/lsu /3/t ter-/i 6il/ onsentr/si terl/lu tin77i4/t/u 6/h/n terse6ut 6ersi;/t irit/n 6il/ /l/ e///n tertutu3 ini ise6/6/n /ren/ e;e te/n4ter-/i 6il/ en77un//n 6/h/n 3//t. Re/si ne7/ti>e 3/lsu /3/t ter-/i is/ln/ onsentr/si terl/lu ren/h4>ehiulu ti/ te3/t46/h/n u-i te3el ti/ ele/t en7/n 6/i4/t/u lon77/r /i6/t 3er7er//n4ur/n7 5uu3 8/tu 3en7henti/n 3e//i/n ortiosteroi sistei /t/u to3i5/l 3oten /n7 l// i3//i 3// /re/ u-i te3le il/u/n.
PE,A!ALAKSA,AA, 8Pen*ega(an $an Pengo5atan9
U3// 3en7o6/t/n DKI /n7 ter3entin7 //l/h en7hin/ri 3er-/l/n/n 6/h/n irit/n46/i /n7 6ersi;/t e/ni4;isis /u3un ii/8i4sert/ enin7ir/n ;/5tor /n7 e3er6er/t.6il/ h/l ini /3/t il/s/n//n en7/n se3urn/ /n ti/ ter-/i o3li/si4// DKI terse6ut //n se6uh en7/n senirin/ t/n3/ 3en7o6/t/n to3i/l4un7in 5uu3 en7/n 3ele6/6 untu e3er6/ii ulit /n7 erin7. A3/6il/
i3erlu/n4untu en7/t/si 3er//n7/n /3/t i6eri/n ortiosteroi to3i5/l4is/ln/ hiro5ortison4/t/u untu el/in/n /n7 ronis /3/t i/8/li en7/n ortiosteroi /n7 le6ih u/t. ,e//in /l/t 3elinun7 iri /n7 /eu/t i3erlu/n 6/7i ere/ /n7 6eer-/ en7/n 6/h/n irit/n4se6/7/i s/l/h s/tu u3// 3en5e7/h/n PRO+,OSIS
+il/ 6/h/n irit/n 3ene6/6 er/titis terse6ut ti/ /3/t i sin7ir/n en7/n se3urn/4// 3ro7nosisn/ ur/n7 6/i4e///n ini serin7 ter-/i 3// DKI ronis /n7 3ene6/6n/ ulti ;/5tor4-u7/ 3// 3enerit/ /to3i
DA-!AR PUS!AKA
Ahi *u/n/4 2009. Ilu ,en/it Kulit /n Kel/in. FKUI K/rnen4 2009. IMMUNO'O)I DASAR. FK UI
Sher8oo4 '/ur/lee. 2012 . Fisiologi Manusia Dari Sel ke Sistem *//rt/ : &)
